Jaipuria Jiten, Kaur Ishleen, Doja Mohammad Najmud, Ahmad Tanvir, Singh Amitabh, Rawal Sudhir Kumar, Talwar Vineet, Sharma Girish
Uro-oncology division, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India.
Amity Centre for Cancer Epidemiology and Cancer Research, Amity Institute of Biotechnology, Amity University, Noida, India.
Curr Urol. 2024 Jun;18(2):104-109. doi: 10.1097/CU9.0000000000000217. Epub 2024 Jun 21.
The incidence of prostate cancer is increasing worldwide. A significant proportion of patients develop metastatic disease and are initially prescribed androgen deprivation therapy (ADT). However, subsequent sequences of treatments in real-world settings that may improve overall survival remain an area of active investigation.
Data were collected from 384 patients presenting with de novo metastatic prostate cancer from 2011 to 2015 at a tertiary cancer center. Patients were categorized into surviving (n = 232) and deceased (n = 152) groups at the end of 3 years. Modified sequence pattern mining techniques (Generalized Sequential Pattern Mining and Sequential Pattern Discovery using Equivalence Classes) were applied to determine the exact order of the most frequent sets of treatments in each group.
Degarelix, as the initial form of ADT, was uniquely in the surviving group. The sequence of ADT followed by abiraterone and docetaxel was uniquely associated with a higher 3-year overall survival. Orchiectomy followed by fosfestrol was found to have a unique niche among surviving patients with a long duration of response to the initial ADT. Patients who received chemotherapy followed by radiotherapy and those who received radiotherapy followed by chemotherapy were found more frequently in the deceased group.
We identified unique treatment sequences among surviving and deceased patients at the end of 3 years. Degarelix should be the preferred form of ADT. Patients who received ADT followed by abiraterone and chemotherapy showed better results. Patients requiring palliative radiation and chemotherapy in any sequence were significantly more frequent in the deceased group, identifying the need to offer such patients the most efficacious agents and to target them in clinical trial design.
前列腺癌的发病率在全球范围内呈上升趋势。相当一部分患者会发展为转移性疾病，最初会接受雄激素剥夺疗法（ADT）。然而，在现实环境中可能改善总体生存率的后续治疗顺序仍是一个积极研究的领域。
收集了2011年至2015年在一家三级癌症中心初诊为转移性前列腺癌的384例患者的数据。在3年结束时，将患者分为存活组（n = 232）和死亡组（n = 152）。应用改进的序列模式挖掘技术（广义序列模式挖掘和使用等价类的序列模式发现）来确定每组中最常见治疗组合的确切顺序。
作为ADT的初始形式，地加瑞克仅在存活组中出现。ADT后接阿比特龙和多西他赛的治疗顺序与较高的3年总生存率独特相关。在对初始ADT反应持续时间较长的存活患者中，睾丸切除术接己烯雌酚磷酸盐有独特的优势。在死亡组中，接受化疗后放疗和接受放疗后化疗的患者更为常见。
我们在3年结束时确定了存活和死亡患者中的独特治疗顺序。地加瑞克应是ADT的首选形式。接受ADT后接阿比特龙和化疗的患者显示出更好的结果。在死亡组中，以任何顺序接受姑息性放疗和化疗的患者明显更多，这表明需要为这类患者提供最有效的药物，并在临床试验设计中针对他们。
